When a medical claim is denied

You went to the doctor, handed over your insurance card, and took care of your co-pay only to find later that your insurance claim was denied! Before you stress, take a deep breath, and consider these tips:

Why was your claim denied? It could be as simple as a medical coding error, the fact that your insurance information was incomplete, or that the procedure wasn’t authorized properly. It could even be that the amounts are simply incorrect.

You will want to make phone calls with your doctor, medical facility, and insurance company to find out the answer to “Why?” Have your insurance card in hand as well as any Statement of Benefits and bills. Try to remain calm during any conversations. Sometimes it takes some time, paperwork, and digging.

You don’t have to try to figure this out all alone. Work with your health insurance company, doctors, and medical facility. Some places even have social workers or health advocates who can help you through this process. Remember you are working with these professionals. They may not be able to fix it immediately; it may take resubmitted information, a letter or even phone calls on their end.

Don’t forget to document all conversations you have regarding the denied claim. Also make sure you keep a paper trail – this can be electronic or even a paper file – for any future questions.

Once you have all the proper answers and paperwork, simply resubmit your claim. This process may result in more questions, phone calls, and multiple attempts to resubmit a claim, but don’t give up. If your claim is still denied, remember that you can work with your doctors and hospital to negotiate the final amount you’ll pay and the time frame you have to pay it.